800-pound woman risks surgery for a new life

Woman risks it all for a new life

Published 6:30 am, Friday, February 23, 2007

Renee Williams, with her boyfriend at Houston's Renaissance Hospital, underwent gastric bypass surgery Tuesday. Her doctor says he thinks the 29-year-old could lose more than 600 pounds.

Renee Williams, with her boyfriend at Houston's Renaissance Hospital, underwent gastric bypass surgery Tuesday. Her doctor says he thinks the 29-year-old could lose more than 600 pounds.

Photo: NICK De La TORRE PHOTOS, CHRONICLE

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Because of post-op swelling, Williams was slightly over her pre-surgery weight.

Because of post-op swelling, Williams was slightly over her pre-surgery weight.

Photo: Nick De La Torre, CHRONICLE

800-pound woman risks surgery for a new life

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Until she came to Houston's Renaissance Hospital two weeks ago, Renee Williams hadn't left her bed in three years. It took eight people to get her in and out of the ambulance. At her first weigh-in at the hospital, she tipped 850 pounds.

Williams this week became what's thought to be the largest female patient to undergo laparoscopic gastric bypass surgery, the increasingly popular solution to morbid obesity. Her doctor said he's optimistic her weight may drop to as low as 200 pounds in two years.

"I feel like I've been run over by a truck," an exhausted Williams said Wednesday, a day after the surgery. "But it's worth it if I can get my independence back, take my kids to the park, just be able to get around on my own."

Williams, 29, was resting relatively comfortably Thursday, free of the complications that can ensue when a patient is so big. But it will be at least 10 days before the hospital declares her out of danger and expects to release her, officials said.

She should lose 60 pounds in the first 90 days as her metabolism improves, said Dr. Younan Nowzaradan, her surgeon. He said it's possible she'll have up to 150 pounds of excess skin removed in that time.

The surgery followed a year and a half in which Williams sought a surgeon. More than a dozen turned her down, most, she said, after she told them she was on Medicaid. She says she screamed for joy when Nowzaradan took her case.

The surgery took five hours, three or four more than it would have if the patient was, say, 400 pounds. The operating team had to improvise equipment to accommodate Williams, who took up two operating tables. They spent the first hour trying to determine the best spots to make incisions and used a special orthopedic lifting device to raise her abdominal wall.

Frequent solution

The procedure, once frowned on by mainstream doctors, has soared in popularity, with more than 140,000 expected to be performed this year. It makes the stomach smaller and bypasses part of the small intestine, resulting in a patient who feels full more quickly, has less of an appetite and absorbs fewer calories.

But it typically is performed on people with a BMI, or body mass index, between 35 and 60. (The obesity classification begins at 30.) In those cases, there is a small risk — it kills one in every 100 or 200 patients.

It is significantly riskier in patients the size of Williams, who has a BMI of 137.5. But the benefits still outweigh the risks, experts say.

"There's no question that it's a dangerous procedure in those cases," said Dr. Garth Davis, medical director of The Methodist Hospital's weight-loss surgery program. "But it's not as dangerous as being that heavy. Without the surgery, there's a 100 percent chance a patient that size will die in 5 years."

Davis said he is skeptical Williams can get to 200 pounds. Noting bariatric surgery patients usually lose about 50 percent to 60 percent of their weight, he said Williams will do well if she can maintain her weight at 300 pounds.

Williams has been overweight since she was a child. The child of heavy parents, she weighed 299 pounds when she was in seventh grade. She saw nutritionists and tried diet pills but couldn't lose weight.

She married at 15, had her first child the next year and "hung in at 299 for a while" before passing 300. The weight never came back down and, five years later, she had her second child. By 2003, she weighed more than 400 pounds.

In June of that year, driving in her hometown of Austin, Williams was hit by a drunken driver. The accident partially crushed one of her legs and left her unable to walk. Bed-bound the next three years, she gained 450 pounds.

"I didn't realize I was gaining weight as fast as I was," said Williams, who in October won a $1.5 million settlement against the driver and restaurant where he'd been drinking. "It was a great shock when the hospital, which had to order a larger scale, determined how much I'd gained."

'The desperate stage'

It was especially hard on Williams, who said that despite her size, she was active and independent before the wreck. Suddenly, she was unable to go to the bathroom, wash herself or attend her daughter's play.

A year and a half ago, when the scale hit 873, Williams decided to have the procedure.

Nowzaradan previously had performed the surgery on five people who weighed more than 600 pounds. He said that Williams' surgery was technically difficult and time consuming, but that it went smoothly.

Renaissance Hospital, a small hospital whose bariatric program has received Center of Excellence accreditation from the American Society for Bariatric Surgery, said Williams' stay should cost between $100,000 to $150,000, some of which the hospital will write off as charity. Williams is paying the rest through a trust fund set up from the settlement.

"These sorts of patients are at the desperate stage," Nowzaradan said. "They're willing to have this surgery, risks and all, because their quality of life is so bad."

Nowzaradan said Williams' chances are good because she's young and in reasonably good health, except for the crushed leg that still needs corrective surgery and is six inches shorter than the other — she doesn't have high blood pressure, high cholesterol or diabetes.

But Williams said she knows the surgery is just the first step, to be followed by therapy, proper diet and exercise.

"I have a lot more steps to go," Williams said. "But the thought of regaining my independence is more than enough to keep me motivated."